title: Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy.
abstract: BACKGROUND
  Delirium is common in the early stages of hospitalization for a variety of acute and chronic diseases.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of two delirium screening tools, the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
  
  
  METHODS
  We searched MEDLINE, EMBASE, and PsychInfo for relevant articles published in English up to March 2013. We compared two screening tools to Diagnostic and Statistical Manual of Mental Disorders IV criteria. Two reviewers independently assessed studies to determine their eligibility, validity, and quality. Sensitivity and specificity were calculated using a bivariate model.
  
  
  RESULTS
  Twenty-two studies (n = 2,442 patients) met the inclusion criteria. All studies demonstrated that these two scales can be administered within ten minutes, by trained clinical or research staff. The pooled sensitivities and specificity for CAM were 82% (95% confidence interval [CI]: 69%-91%) and 99% (95% CI: 87%-100%), and 81% (95% CI: 57%-93%) and 98% (95% CI: 86%-100%) for CAM-ICU, respectively.
  
  
  CONCLUSIONS
  Both CAM and CAM-ICU are validated instruments for the diagnosis of delirium in a variety of medical settings. However, CAM and CAM-ICU both present higher specificity than sensitivity. Therefore, the use of these tools should not replace clinical judgment.
authors.affiliation: Health and Rehabilitation Sciences, Western University, London, Ontario, Canada ; Stroke Outcomes Research Center, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Qiyun
authors.initials: Q
authors.lastname: Shi
authors.forename: Laura
authors.initials: L
authors.lastname: Warren
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Joy C
authors.initials: JC
authors.lastname: Macdermid
keywords: confusion assessment method; delirium; diagnostic accuracy; meta-analysis; systematic review